Employee Health Benefits - 2022 ENROLLMENT GUIDE - Benefits that deliver choice, flexibility and value
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Employee Health Benefits 2022 ENROLLMENT GUIDE Benefits that deliver choice, flexibility and value
Choice. Table of contents
Flexibility.
1 What’s changing for 2022
2
Value.
2022 enrollment overview
Choosing the medical plan that’s
8 right for you
The Public Employee Benefits
Cooperative (PEBC) offers a variety
18 Saving on prescription medications
of benefits and programs to help you Enhancing well-being with vision
22 and dental benefits
manage your health while keeping
benefit costs affordable. In this 26 Getting the right care at the right time
guide, you’ll find information on
your 2022 health plan benefits to 34 Saving money using pretax dollars
help you choose the coverage that 38 Supporting financial security
works best for you.
42 Tools to help you manage the details
Questions? Please contact your
Human Resources department. 44 2022 important notices
KEEP READING TO LEARN MORE >
b Employee Health Benefits 2022 Enrollment Guide
NEW
What’s changing Required
for 2022 enrollment action
Here’s an overview of what Spouse Medical Plan Surcharge Affidavit
you can expect If your medical coverage includes your spouse, you
must sign a “Spouse Medical Plan Surcharge Affidavit”
Health savings account during annual enrollment confirming their access
(HSA) contributions to employer medical plan coverage through their
The maximum contribution to an HSA for 2022 is employer — regardless of whether they enrolled in
$3,650 for individuals and $7,300 for families, with that coverage. Verify submission requirements and
deposits made through payroll deduction. If you deadlines with your employer. Visit pebcinfo.com to
are age 55 or older, you can make an extra catch-up get a copy of the form.
deposit of $1,000 in 2022.
Medical plan spouse surcharge
Flexible spending account If your spouse’s employer offers a medical plan, your
(FSA) contributions spouse did not enroll in that plan and you cover your
You must elect an FSA every year you intend spouse in your employer PPO medical plan or HDP, a
to participate. The maximum amount you can $200 per month spouse surcharge will apply to the
set aside for 2022 is $2,750 — including general- cost of covering your spouse on your employer medical
purpose FSAs and limited-purpose FSAs plan (deducted from your paycheck).
(LP-FSAs). Employer contributions do not count
toward the annual limit. To help pay for qualifying The surcharge will also apply if you fail to turn in the
day care expenses, you can set aside up to $5,000 required Spouse Medical Plan Surcharge Affidavit or if
in the dependent care FSA in 2022, which cannot you were late turning it in.
be used for medical expenses.
The medical plan spouse surcharge will not apply if:
New vision plan administrator • Your spouse is enrolled in dental and vision coverage.
Starting Jan. 1, 2022, VSP will be administering • Your spouse is enrolled in both their employer
the PEBC vision plan. Although VSP matched the medical plan (proof of enrollment required) and your
previous plan, there could be slight changes to PPO plan or HDP; or
coverage, and Denton County is now offering
• Your spouse does not work outside the home and has
a high/low option. In addition, the contact
no access to employer coverage; or
information for your vision plan will change. For
more information, turn to page 22 of this guide. • Your spouse’s employer does not offer medical
coverage, or your spouse is not eligible for that
New dental plan administrator coverage; or
Starting Jan. 1, 2022, Delta Dental will be • Your spouse’s other coverage is Medicare, Medicaid,
administering PEBC dental plan benefits. While TRICARE or care received at a Department of Veteran
there are no changes to coverage, the contact Affairs (VA) facility; and
information for your dental plan will change. For • You turned in the required Spouse Medical Plan
more information, turn to page 24 of this guide. Surcharge Affidavit on time.
PLEASE NOTE: The surcharge will apply for each
month the Spouse Medical Plan Surcharge Affidavit
was not submitted (even if the surcharge does not
apply or if it was submitted late) or if you fail to
notify your employer of a change, which would have
triggered or stopped the surcharge.
Employee Health Benefits 2022 Enrollment Guide 1
Enrolling in Helpful tools
your 2022 The following resources can help
you choose the right plan, get
medical plan the most out of your health plan
benefits and maybe even save you
time and money.
How to select a plan
Annual enrollment is the only time of the year
that you can change your benefit elections or pebcinfo.com
dependents without a qualified change in status
Go to pebcinfo.com and click the button for your
event. It’s important to read your plan options
employer group.
closely to help you make the choices that are best
for you. Here are a few helpful things to remember. • To compare plans, check the Summary of
Benefits and Coverage (SBC). The SBC helps you
• Compare the differences between the plans. compare certain health plan provisions.
• Check which doctors, hospitals and providers • To see employee contribution rates for each plan
are in the network. Both plans offered through along with the various account options available
PEBC use the large UnitedHealthcare Choice to you (HSA, FSA, LP-FSA), view the 2022
Plus network. Employee Benefits Rate Sheet.
• Think about potential health needs in the coming
myuhc.com®
year. Estimate your out-of-pocket cost for each
available plan for services you might receive, as Register for an account on myuhc.com and you’ll
well as the premium cost. be able to locate a network provider nearby,
estimate costs for care, verify FSA balances or
• If you enroll in the HDP, consider the additional
transactions, link to Live and Work Well for mental
savings and benefits of the health savings account
health and Employee Assistance Program (EAP)
(HSA), especially if partnered with a limited-
services, schedule a 24/7 Virtual Visit, access your
purpose flexible spending account (LP-FSA).
HSA and much more.
Your employer contributes “seed money” to your
HSA to help you save even more. If you are not • Use the cost estimator to help estimate your
eligible for HSA contributions, the seed money out-of-pocket costs, compare treatment options
goes to an LP-FSA. and select a quality provider for a procedure.
• If you enroll in the PPO plan or opt out of medical • Access myClaims Manager to help manage your
coverage, you can also save by electing a health claims and understand your share of the plan
care FSA. cost. You can view your deductible, annual
out-of-pocket maximum and claims history.
NOTE: During annual enrollment, you must • Select “Find Physician, Laboratory or Facility”
re-enroll if: to find network providers (including Tier 1 and
Premium Care Physicians) and even pay your
• Your employer requires you to re-enroll out-of-pocket costs securely online.
(important deadlines apply)
• Download the UnitedHealthcare® app to access
• Anything changed, including dependent your health plan ID card, find nearby care and
eligibility, your address or your plan choice more right on your phone or mobile device,
• You want to contribute to an FSA or an LP-FSA. anywhere, anytime.
You have to re-enroll each year if you want
to contribute to an FSA, even if you do not caremark.com
change your annual election amount. Log in to or download the CVS Caremark® app to
manage your prescription drug benefits.
2 Employee Health Benefits 2022 Enrollment Guide
Dependent eligibility
Who is an eligible dependent?
Your dependent can be enrolled in a plan only if they are an eligible
dependent. If both you and your spouse work for the same employer,
your dependents can be covered by only one of you.
Eligible spouse
• Your lawful spouse (You must have a valid certificate of marriage
considered lawful in the State of Texas or a signed and filed legal
Declaration of Informal Marriage considered lawful in the State of Texas.)
• A surviving spouse of a deceased retiree, if the spouse was covered at
the time of the retiree’s death
Eligible child(ren)
• Your natural child under age 26
• Your natural, mentally or physically disabled child, if the child has reached
age 26 and is dependent upon you for more than one-half of their
support as defined by the Internal Revenue Code. To be eligible, the
disability must occur before or within 31 days of the child’s 26th birthday.
• Your legally adopted child, including a child who is living with you who
has been placed for adoption or for whom legal adoption proceedings
have been started, or a child for whom you are named Permanent
Managing Conservator
• Your newborn is not automatically enrolled in your medical plan. You
are responsible for contacting your Human Resources department and
completing the required enrollment paperwork to add your newborn.
If you enroll your newborn within 31 days from the date of birth, coverage
is effective on the date of birth. If you do not add your newborn within
31 days from the date of birth, you cannot add your newborn until the
next annual enrollment period.
Managing conservator
• Your stepchild (natural or adopted child of
current spouse)
• Your unmarried grandchild (child of your child)
under age 26 who, at the time of enrollment, is your
dependent for federal income tax purposes, without
regard to income limitations
• A child for whom you are required to provide
coverage by court order
• A surviving, eligible child of a deceased retiree, only
if the child was covered as a dependent at the time
of the retiree’s death
Employee Health Benefits 2022 Enrollment Guide 3
Dependent verification New hire enrollment
Valid proof of dependent eligibility is required before If you are a newly hired employee and selecting
you can add a new dependent or spouse to the plan. benefits for the first time:
Check with your Human Resources department for
• You must return your enrollment documents to
more information.
your Human Resources department within 14
days of the date you begin working. If you miss
Who is not an eligible dependent? that deadline, you’ll automatically be enrolled in a
default medical plan, employee-only coverage.
Enrollment of an ineligible dependent can be considered
• The PPO is the default medical plan. You cannot
fraud and subject you to penalties, including termination of
change from PPO default plan enrollment until
employment, financial risk and criminal prosecution. Anyone
the next annual enrollment period unless you
eligible as an employee is not eligible as a dependent.
experience a qualified change in status event.
Ineligible spouse • Your coverage becomes effective on the first day
of the month after 30 consecutive calendar days
• Your divorced spouse, or a person to whom you are not
of active, regular employment.
lawfully married, such as your significant other
• If you select optional Term Life insurance (TLF)
• A surviving spouse who was not covered by the
when you are newly hired and enrolling for the
deceased retiree at the time of the retiree’s death
first time, you do not have to provide Evidence
of Insurability (EOI). If you select spouse optional
Ineligible child(ren) Term Life (SLF) in an amount greater than $25,000,
• Your natural, age-26-or-older child who is not disabled EOI is required. Instructions are found on the back
or whose disability occurred after the 26th birthday of the enrollment form, available at pebcinfo.com.
• A child for whom your parental rights have TLF coverage requirements vary by employer.
been terminated Check with your employer to confirm your
EOI requirements.
• A child living temporarily with you, including a foster
child who is living temporarily with you or a child placed
with you in your home by a social service agency, or a
child whose natural parent is in a position to exercise or
share parental responsibility or control
• Your current spouse’s stepchild or the stepchild of a
former spouse
• A surviving child of a deceased retiree who was not
covered as a dependent at the time of the retiree’s death
• A sibling, another family member or an individual not
specifically listed by the plan as an eligible dependent
When a child’s coverage ends
You may cover your child (natural child, stepchild, adopted
child) in a medical, dental and/or vision plan until the last
day of the month in which the child turns age 26, whether
or not the child is a student, working, living with you and
regardless of the child’s marital status. This coverage does
not extend to your child’s spouse or their children. Your
grandchild is eligible only if the grandchild is unmarried
and your dependent for federal income tax purposes.
You must provide your Form 1040 to prove grandchild
dependent status.
4 Employee Health Benefits 2022 Enrollment Guide
Change in status Examples of events that do not qualify:
• Your doctor or provider is not in the network.
IRS regulations state that unless you experience a
• You prefer a different medical plan.
qualified change in status event (described below),
you cannot change your benefit choices until the next • You were late turning in your paperwork.
annual enrollment period.
Change in employment status
The qualified change in status event must result in The following changes in the employment status of an
either becoming eligible for or losing eligibility under employee, spouse or dependent may affect benefit
the plan. The change must correspond with the specific eligibility under your benefit plan or the employer
eligibility gain or loss. As long as the qualified change benefit plan of your spouse or your dependent:
in status event is consistent, you may also change your
• Switching from a salaried to an hourly paid job
corresponding FSA elections, dependent life insurance
(or vice-versa)
elections or your health benefit elections.
• Reduction or increase in hours of employment,
such as going from part-time to full-time
Qualified events
• Any other employment-related change that results
Change in family status in becoming eligible for or losing eligibility for a
particular plan
Applies to employee, employee’s spouse or
employee’s dependents: • Termination or commencement of employment
• Marriage, divorce or annulment • Strike or lockout
• Death of your spouse or dependent • Start or return from an unpaid leave of absence
• Child’s birth, adoption or placement for adoption • USERRA (military) leave
(your newborn or adopted child is not automatically
enrolled in your medical plan)
• An event causing a dependent to no longer meet
eligibility requirements, such as reaching age 26
Important deadlines apply
You must take action within 31 days of the qualifying event —
coverage elections are not retroactive.
• 31-day notification rule — You must notify your Human Resources
department of the event AND turn in required paperwork (including
proof of the change) within 31 days of the event date.
• Effective date — The change is effective the first day of the month
following the date you notified your employer of the qualified
change in status event. Effective date exception: Newborns are
effective on the date of birth, and adoptions are effective the date
placed for adoption or on the adoption date.
Employee Health Benefits 2022 Enrollment Guide 5
Retirement
Thinking about retirement? CAUTION: If you are preparing to
Your employer offers retiree health benefits, but retiree health benefits retire and you or your spouse are
cost more than your active employee coverage. Make an appointment age 65 or older or turning 65 soon,
to discuss your retiree benefit options with your Human Resources you must contact the Social Security
department at least 60 days before you retire. Administration to enroll in Medicare
Part A and Part B. If you delay,
If you are age 65 or older, or if you are turning 65 soon, contact the your Medicare enrollment can be
Social Security Administration at least 90 days before you retire. Carefully delayed, and you may be subject to
review the Retiree Health Benefits Guide, available at pebcinfo.com or a higher Part B premium.
from your employer.
After you retire, Medicare becomes
Turning age 65 and still working primary for you and your Medicare-
eligible spouse. You may be eligible
Most people become eligible for Medicare when they turn 65. If you are
for your employer’s Medicare
still working and covered under your employer’s plan, you can delay your
Advantage HMO or PPO retiree
Medicare enrollment until you retire.
plans but only if you are enrolled in
both Medicare Part A and Part B.
If you are already collecting Social Security payments, you are
automatically enrolled in Part A. Otherwise, you may choose to delay your
Medicare enrollment until you retire for several reasons, including:
• You are an active employee and you (and your spouse, regardless of
spouse’s age) are enrolled in the employer health plan.
• You (and your spouse, regardless of spouse’s age) want to delay
payment of Part B premium.
• You still want contributions to be made to your HSA (as long as you are
not enrolled in Medicare and you are enrolled in the HDP).
6 Employee Health Benefits 2022 Enrollment Guide
Retired public safety officers: The HELPS ACT
If you are a retired public safety officer and you enroll in the retiree
group health plan, you may benefit from a tax savings provision
known as the HELPS Act.
Federal law permits eligible retired public safety officers to exclude
up to $3,000 of their qualified health insurance premiums from
their gross taxable income each year as long as the premiums are
deducted from their retirement benefit. This means your health
premium must be deducted from your TCDRS monthly retirement
benefit to qualify for the tax savings.
Contact your Human Resources department (not TCDRS) for
additional information and the required enrollment form. Information
is also available at pebcinfo.com (select “employer member group,”
then select “retiree” from the top menu for retiree information
specific to your employer).
If you are currently enrolled, you do not need to enroll again.
Employee Health Benefits 2022 Enrollment Guide 7
Choosing the
medical plan
that’s right
for you
Understanding how much you can expect to pay
Your out-of-pocket costs and your deductible — the amount you must pay
each year before the plan begins to pay — will be different, depending on
the plan you choose.
PPO
With this plan, you pay a fixed copay for many services, which count toward
your out-of-pocket costs. Copays do not count toward the deductible.
Network deductibles Out-of-network deductibles
For 2022, your deductible for The individual out-of-network
services in the network is: deductible applies to each
enrolled family member
and does not have a family
deductible limit:
$500 for individual $1,000 for each
(single) coverage individual (single)
$1,000 for family coverage* Unlimited for family coverage
Need more details?
Visit pebcinfo.com.
*If you cover family members, the network family deductible is met when the combined
eligible network expenses for you and/or your covered family members reach $1,000. If one
family member reaches $500 but the combined family deductible of $1,000 has not been met,
the member who met the $500 deductible can move to coinsurance until one more family
member reaches the deductible. If no family member reaches the $500 deductible but the
combined family deductible is met, all family members move to coinsurance.
8 Employee Health Benefits 2022 Enrollment GuideHDP
The HDP does not use copays. You pay 100% of the allowable cost
for network services — including office visits, urgent care, prescription PLEASE NOTE: If your employer
drugs, emergency room visits and other covered expenses — until your contributes to a health care FSA
deductible is met. Once the deductible is met, you pay a portion of the due to your medical plan opt-out
costs as coinsurance. status, that contribution is subject
to valid proof of other comparable
The deductibles are another big difference between this plan and the coverage and a current, signed
PPO plan: Certification of Other Coverage
form. If your other coverage is
• $1,500 individual (single) deductible
found to be invalid or expired,
• $3,000 family deductible* the employer contribution
is discontinued. You may be
*If you cover any family member, the entire network family deductible must be met before
required to repay any employer
any family member can move to coinsurance. The HDP network family deductible is met
when the combined eligible expenses for you and/or any covered family members reach
contributions, and you could be
$3,000. Even if one family member reaches the $1,500 deductible, that member cannot subject to serious consequences.
move to coinsurance until the full $3,000 family deductible is met. Participation or continuation of any
employer contribution program is
at the discretion of the employer.
Opting out of a medical plan
Coverage obtained through
You may be able to opt out of your employer’s medical plan if you the Health Care Marketplace
submit the following to your Human Resources department before (Exchange) is not eligible for
the enrollment deadline: employer opt-out contributions.
• Valid proof of other comparable medical plan coverage that meets
minimum essential coverage rules under the Affordable Care Act (ACA),
confirmed by your employer
• A completed “Certification of Other Coverage” form
If you do not provide a Certification of Other Coverage form, or if your
proof of coverage is found to be invalid, your employer can enroll you in
the PPO plan (employee-only coverage). If you opt out, you will not be
eligible for continuation of medical coverage (COBRA). Examples of Questions?
coverage that cannot be used to opt out of your employer’s medical Talk to your
plan include:
Human Resources
• Medicaid • Student insurance representative.
• TRICARE “supplemental” coverage • Coverage that does not meet
• Marketplace minimum ACA requirements
Transition benefits
Are you new to the HDP or PPO plan? Transition of Care is a service that
enables new enrollees to receive time-limited care for specific medical
conditions from an out-of-network doctor but at the network benefit level.
Complete Sections 1 and 2 of the Application for Transition of Care form
(available at pebcinfo.com or from your Human Resources department).
Ask your doctor to complete Section 3 and forward to UnitedHealthcare
no later than 30 days after your benefits become effective. Transition
benefits may apply if you are in your second or third trimester of
pregnancy, a high-risk pregnancy, in nonsurgical treatment (radiation,
chemotherapy) for cancer, treatment for symptomatic AIDS, treatment for
severe or end-stage kidney disease, or if you are on the waiting list for or
recently underwent a bone marrow or organ transplant.
Employee Health Benefits 2022 Enrollment Guide 9Understanding HSAs
4
things you
What is an HSA?
need to know
An HSA is a savings account that you can use to help cover qualified
health care expenses. You must be enrolled in a high-deductible health about HSAs
plan to participate. Unlike an FSA, there is no “use it or lose it” rule and
it comes with triple-tax benefits:
• Deposits are income tax-free • Withdrawals made for qualified The PEBC HDP is an HSA-eligible
• Savings grow tax-free expenses are also income tax-free plan. You can deposit funds in an
HSA if:
For 2022, you can contribute $3,650 through payroll deduction if you 1. You are covered under an
have individual coverage or $7,300 if you have family coverage. The IRS eligible high-deductible plan
also allows catch-up contributions of $1,000 if you are age 55 or older. (like the HDP).
2. You are not covered by another
Your HSA
medical plan (unless it is an HDP)
An HSA will be opened with Optum Bank® for all newly enrolled HSA or a general-purpose FSA.
participants. Once your account is opened, you will receive a Welcome
Kit in the mail. As long as you maintain an account balance of $500 or 3. You are not enrolled in Medicare.
more, you will not be charged the $1 monthly account maintenance
fee. If your account balance is $2,000 or more, you can choose to invest 4. You cannot be claimed as a
funds — look for details in your Welcome Kit. dependent on someone else’s
tax return.
Contributions from your employer
If you enroll in the HDP during annual enrollment, your employer
will make a one-time cash deposit to your HSA in January. For new
PLEASE NOTE: Some other restrictions
employees, these “seed money” contributions are available as soon
apply, especially if you receive services
as possible once your HDP becomes effective.
at a VA facility or clinic. Contact your tax
or financial advisor if you have questions.
If you are not eligible for HSA contributions — for example, if you are
If you switch to a health plan that makes
enrolled in Medicare — the seed money contribution will go to an
you ineligible to continue depositing
LP-FSA. Seed money is not offered to those who add coverage in
money in an HSA, you can continue to use
the high-deductible plan as a result of a mid-year qualifying event.
the money in your account for qualified
medical expenses, but you can no longer
make deposits.
If you enroll in the HDP with an HSA, Build your balance
be sure to save receipts. You can also make pretax contributions
You are responsible for verifying your HSA was to your HSA, up to IRS limits, to help
used for eligible medical expenses under the IRS your account grow.
tax code. Contact Optum Bank for details.
10 Employee Health Benefits 2022 Enrollment GuideUnitedHealth Premium® program
Choosing a doctor is one of the most important health decisions you’ll make.
Studies show that people who actively engage in their health care decisions have
fewer hospitalizations, fewer emergency visits, higher utilization of preventive care
and overall lower medical costs. Take an active part in your health by seeking out
and choosing providers with the help of the UnitedHealth Premium program.
Choosing a Premium Care Physician
The UnitedHealth Premium program makes it easy for you to find doctors who
meet benchmarks based on national standards for quality and cost efficiency.
The program evaluates physicians in various specialties using evidence-based
medicine and national standardized measures. If a doctor does not have a Premium
designation, it does not mean he or she provides a lower standard of care. It could
mean that the data available to us was not sufficient to include the doctor in the
program or that the doctor practices in a specialty not evaluated as a part of the
Premium program. Learn more at unitedhealthpremium.com.
The UnitedHealth Premium® designation program is a resource for informational purposes only.
Designations are displayed in UnitedHealthcare online physician directories at myuhc.com®. You should
always visit myuhc.com for the most current information. Premium designations are a guide to choosing a
physician and may be used as one of many factors you consider when choosing a physician. If you already
have a physician, you may also wish to confer with him or her for advice on selecting other physicians.
Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please
visit myuhc.com for detailed program information and methodologies.
To find Premium
Care Physician, look
for two blue hearts
on myuhc.com.
Employee Health Benefits 2022 Enrollment Guide 11Mental health support
Sometimes a little extra help can go a long way. Your To view information on your mental health benefits
benefits include behavioral health support provided by coverage, search for a provider or access online
United Behavioral Health, with some resources that can resources, visit myuhc.com > Coverage & Benefits >
be accessed right at home. From everyday challenges Mental Health.
to more serious issues, support is on your side.
Resource How it works How to access
Live and Find support for a variety of concerns, including: Visit liveandworkwell.com and
Work Well • Anxiety and stress enter access code: PEBC
• Alcohol and drug use
• Coping with grief and loss
• Marital problems
• Eating disorders
• Compulsive spending or gambling
• Medication management
Talkspace Communicate with a licensed therapist via text or live video Register at talkspace.com/connect
from your phone or desktop. It’s private, confidential and
convenient. Five days of unlimited texting via the Talkspace
app equals one in-person office visit through either your
EAP or behavioral health benefit.
Virtual Talk to a psychiatrist or therapist without leaving your home. • Sign in to liveandworkwell.com.
behavioral These providers can evaluate and treat general mental • Select Find a Resource >
health visits health conditions such as depression and anxiety. virtual visits.
• Choose Get Started. You can
schedule an appointment online
or by phone.
In-person From everyday challenges to more serious issues, you can Search for a provider near you on
behavioral receive confidential help with a psychiatrist or therapist for: liveandworkwell.com.
health visits • Depression, stress and anxiety
• Substance use and recovery
• Eating disorders
• Parenting and family concerns
Sanvello™ Dial down the symptoms of stress, anxiety and depression Download the app at sanvello.com.
with an app that uses clinical techniques. Sanvello premium
access is available at no extra cost as part of your behavioral
health benefit.
Substance Speak with a substance use recovery advocate who will Call 1-855-780-5955 or visit
Use listen, provide support and develop personalized recovery liveandworkwell.com/recovery to
Treatment plans. The helpline is available 24/7 as part of your benefits find care options and resources.
Helpline and is completely confidential — you can even choose to
remain anonymous.
These services and programs are for informational purposes only and should not be used for emergency or urgent care needs. In an emergency,
call 911 or go to the nearest emergency room. This content is for informational and/or educational purposes only. It is not meant to be used in
place of professional clinical consultations for individual health needs. Certain treatments may not be covered in some benefit plans.
12 Employee Health Benefits 2022 Enrollment GuideEmployee Assistance Program
The EAP is completely confidential and is provided to employees Call the EAP 24/7 at
at no cost, regardless of the medical plan you selected. Even if you
opt out of medical coverage, the EAP is available to you. Dependents 1-866-248-4096
who live away from home are also eligible.
The EAP is staffed by licensed clinicians who know how to get you Specialists will be able to
and your family the help you need — right away. When you call, connect you to support for
the specialist will help identify the best resource for your specific help with:
situation by talking with you and asking questions. You can speak to
an EAP specialist as often as you like at no extra cost. • Work and career —
including conflict management,
As part of the program, you and your family also get five face-to-face stress management and
counseling sessions at no extra cost with a network provider (per career counseling
concern, per person, per year). First responders get eight sessions.
• Family and relationships —
You can also meet virtually through a telemental health visit. This
including pregnancy, adoption,
service uses video-calling technology to provide real-time access to
separation or abuse
a behavioral health professional — with no travel and less wait time
for appointments. • Legal and financial services —
including mediation, financial
To learn more about your EAP benefits, go to myuhc.com > planning and financial
Coverage & Benefits > Mental Health > liveandworkwell.com. aid assistance
If you do not have medical coverage through PEBC, visit • Grief — including the loss
liveandworkwell.com, access code: PEBC. of a loved one, infertility,
miscarriage and other difficult
These services and programs are for informational purposes only and should not life changes
be used for emergency or urgent care needs. In an emergency, call 911 or go to the
nearest emergency room. This content is for informational and/or educational purposes
• Child care and elder care —
only. It is not meant to be used in place of professional clinical consultations for including help for teens and
individual health needs. Certain treatments may not be covered in some benefit plans. Medicaid/Medicare
• Life transitions —
including divorce, relocation
and college selection
• Local personal services —
including restaurant
reservations, dog walkers,
plumbers and more
Employee Health Benefits 2022 Enrollment Guide 13PPO plan quick-reference guide
Refer to plan documents for limitations and additional information.
PPO — medical plan
Feature Your network cost Your out-of-network cost
PLUS you pay charges exceeding
plan payment
Annual deductible $500 individual/$1,000 family $1,000 each person
Coinsurance (after the annual 20% after deductible 40% after deductible
deductible is met)
Annual coinsurance maximum $2,500 individual/$5,000 family No limit
Annual out-of-pocket $3,000 individual/$6,000 family No limit
maximum (OOP) Plan pays 100% after annual OOP
Physician services
Office visits $25 primary care physician (PCP) 40% after deductible
$25 Premium Care Specialist
$35 non-Premium Care Specialist
24/7 Virtual Visits $0 copay 40% after deductible
Telehealth $25 PCP 40% after deductible
$25 Premium Care Specialist
$35 non-Premium Care Specialist
Hospital visits 20% after deductible 40% after deductible
Urgent care visit $35 copay 40% after deductible
Preventive care*
Well-child care Covered at 100% 40% after deductible
Well-woman exam Covered at 100% 40% after deductible
Routine screening mammography Covered at 100% 40% after deductible
Adult health assessments Covered at 100% 40% after deductible
Immunizations Covered at 100% 40% after deductible
Screening colonoscopy Covered at 100% 40% after deductible
Maternity services
Routine prenatal care Covered at 100% 40% after deductible
Delivery in hospital 20% after deductible 40% after deductible
Newborn care in hospital (routine) 20% after deductible 40% after deductible
*Subject to Affordable Care Act requirements.
14 Employee Health Benefits 2022 Enrollment GuideHDP quick-reference guide
Refer to plan documents for limitations and additional information.
HDP — medical plan
Feature Your network cost Your out-of-network cost
PLUS you pay charges exceeding
plan payment
Annual deductible* $1,500 individual/$3,000 family $3,000 individual/$6,000 family
Coinsurance (after the annual 20% after deductible 40% after deductible
deductible is met)
Annual coinsurance maximum $1,500 individual/$3,000 family No limit
Annual out-of-pocket $3,000 individual/$6,000 family No limit
maximum (OOP) Plan pays 100% after annual OOP
Physician services
Office visits 20% after deductible 40% after deductible
24/7 Virtual Visits 20% after deductible 40% after deductible
Telehealth 20% after deductible 40% after deductible
Hospital visits 20% after deductible 40% after deductible
Urgent care visits 20% after deductible 40% after deductible
Preventive care**
Well-child care Covered at 100% 40% after deductible
Well-woman exam Covered at 100% 40% after deductible
Routine screening mammography Covered at 100% 40% after deductible
Adult health assessments Covered at 100% 40% after deductible
Immunizations Covered at 100% 40% after deductible
Screening colonoscopy Covered at 100% 40% after deductible
Maternity services
Routine prenatal care Covered at 100% 40% after deductible
Delivery in hospital 20% after deductible 40% after deductible
Newborn care in hospital (routine) 20% after deductible 40% after deductible
*The entire family deductible must be met before benefits pay — unless you selected employee-only coverage.
**Subject to Affordable Care Act requirements.
Employee Health Benefits 2022 Enrollment Guide 15PPO — medical plan (continued)
Feature Your network cost Your out-of-network cost
PLUS you pay charges exceeding
plan payment
Maternity services (continued)
Infertility services: 5 artificial 20% after deductible (excludes 40% after deductible (excludes
insemination visits (lifetime) in vitro and drug coverage) in vitro and drug coverage)
Additional services
Inpatient hospital 20% after deductible 40% after deductible
Outpatient surgery 20% after deductible 40% after deductible
Lab & X-ray outpatient (minor) Covered at 100% in physician 40% after deductible
office or network lab or
radiological provider
Hospital emergency care services $300 copay + 20% after deductible; $300 copay + 20% after deductible;
(treated as network) copay waived if admitted copay waived if admitted
Skilled nursing facility 20% after deductible; 40% after deductible;
up to 60 days annually* up to 60 days annually*
Home health care 20% after deductible; 40% after deductible;
up to 120 visits annually* up to 120 visits annually*
Allergy care services $25 PCP/$25 Premium Care Specialist 40% after deductible
$35 non-Premium Care Specialist
Chiropractic $35 copay per visit; 40% after deductible;
maximum 20 visits per year* maximum 20 visits per year*
Medical supply & equipment (DME) 20% after deductible 40% after deductible
Mental health services
Outpatient visits $25 visit 40% after deductible
Inpatient 20% after deductible 40% after deductible
Serious mental illness Treated like any other illness Treated like any other illness
Substance abuse Treated like any other illness Treated like any other illness
*Limits apply for any combination of network and out-of-network benefits.
16 Employee Health Benefits 2022 Enrollment GuideHDP — medical plan (continued)
Feature Your network cost Your out-of-network cost
PLUS you pay charges exceeding
plan payment
Maternity services (continued)
Infertility services: 5 artificial 20% after deductible; (excludes 40% after deductible; (excludes
insemination visits (lifetime) in vitro and drug coverage) in vitro and drug coverage)
Additional services
Inpatient hospital 20% after deductible 40% after deductible
Outpatient surgery 20% after deductible 40% after deductible
Lab & X-ray outpatient (minor) 20% after deductible 40% after deductible
Hospital emergency care services 20% after deductible 20% after deductible
(treated as network)
Skilled nursing facility 20% after deductible; 40% after deductible;
up to 60 days annually* up to 60 days annually*
Home health care 20% after deductible; 40% after deductible;
up to 120 visits annually* up to 120 visits annually*
Allergy care services 20% after deductible 40% after deductible
Chiropractic 20% after deductible; 40% after deductible;
maximum 20 visits per year* maximum 20 visits per year*
Medical supply & equipment (DME) 20% after deductible 40% after deductible
Mental health services
Outpatient visits 20% after deductible 40% after deductible
Inpatient 20% after deductible 40% after deductible
Serious mental illness Treated like any other illness Treated like any other illness
Substance abuse Treated like any other illness Treated like any other illness
*Limits apply for any combination of network and out-of-network benefits.
Employee Health Benefits 2022 Enrollment Guide 17Saving on
prescription
medications
CVS Caremark
CVS Caremark has approximately 68,000 pharmacies in their national Register at
network, made up of major chains such as CVS Pharmacy, Kroger,
caremark.com
Albertsons, Walmart, Costco and most independent pharmacies across
the United States. Manage your prescriptions
online with tools available
CVS Health’s Standard Control Formulary at caremark.com.
The formulary is the list of safe and effective medications available for
you. Not all medications on the formulary are covered by your plan, • Check the cost of a drug
and some medications are excluded entirely. Not seeing a specific • Find available alternative
medication on the formulary? Talk to your doctor about an alternative medications
that can work for you. For questions, call CVS Caremark Customer • See your prescription history
Service at 1-855-335-7698.
• View balances
Out-of-pocket costs • View the Preferred Drug List
Eligible pharmacy costs count toward your out-of-pocket maximum • Locate a participating
(OOP). There are certain prescription drug expenses that do not count pharmacy
toward the OOP, such as items excluded by the
• And more
plans or the cost difference if you
choose a brand-name drug
instead of a generic.
18 Employee Health Benefits 2022 Enrollment GuideGeneric medications CVS Specialty pharmacy
When it comes to choosing your medications, it pays Specialty drugs are those that are typically more
to shop smart. You can often save (sometimes a lot) if expensive, used to treat complex, chronic conditions,
you choose an available generic drug instead of the and require an enhanced level of care. CVS Specialty
brand-name version. has a team of professionals that help you ensure the
best possible outcomes from your specialty drugs.
PPO plan members: If you choose the brand-name
drug and you are enrolled in the PPO plan, you’ll pay • Medications filled through CVS Specialty are shipped
the applicable copay plus the cost difference between to you in a 30-day supply (not 90-day).
the generic and brand-name drug. Only the generic • The PPO copay is one-third the cost of a 90-day mail-
copay will count toward your OOP. order copay until the PPO out-of-pocket limit is met.
HDP members: If you choose the brand-name drug • If you are enrolled in the HDP, you pay the actual cost
when a generic is available, only the generic cost will until your deductible is met. After your deductible is
apply to your OOP. met, you pay 20% of the actual cost until you meet
the plan’s out-of-pocket limit. Once you reach the
Many retailers offer $4-generic programs (30-day out-of-pocket limit, your plan pays 100% of the cost of
supply) and some offer $10-generic programs specialty drugs filled at CVS Specialty.
(90-day supply). If you are enrolled in the PPO plan,
you will always pay the lesser of the retail cost or Specialty medication
the generic copay. HDP members can also save with Unless your drug is needed on an emergency basis,
these programs. all specialty drugs must be filled through CVS Specialty
or you pay 100% of the cost without credit to your
For prior authorization or coverage review, contact annual out-of-pocket limit. Many specialty drugs have
CVS Caremark at 1-800-294-5979. You can also a copay assistance program that reduces your copay
visit pebcinfo.com. or out-of-pocket cost. CVS Specialty will make you
aware if a copay assistance program applies, and your
actual lower cost will apply to your deductible and/or
out-of-pocket limit.
If you have questions about specialty medications,
call CVS Specialty at 1-800-237-2767 or visit
cvsspecialty.com.
Pharmacy access options PPO plan HDP
Refills allowed as prescribed
CVS Caremark National Network Pharmacy $15 generic • For retail and home
(network) up to a 30-day supply $30 preferred brand delivery pharmacy, you
will pay 100% of the
$60 non-preferred brand CVS Caremark/CVS
CVS Caremark Mail Order Pharmacy up to a $30 generic Specialty cost until you
90-day supply or CVS Caremark Retail-90 meet your deductible.
$60 preferred brand
Network Pharmacies • After deductible, you
$120 non-preferred brand
pay 20% of the cost
until the network
CVS Specialty Pharmacy up to a 30-day supply $10 generic
OOP is met.
$20 preferred brand
• After network OOP,
$40 non-preferred brand plan pays 100%.
Employee Health Benefits 2022 Enrollment Guide 19No-additional-cost contraceptives 90-day prescriptions
(prescription required) Get up to a 90-day supply of your medicine for the
The pharmacy benefit plan covers certain prescriptions you take regularly. If you are enrolled in
contraceptives at no additional cost to you, which the PPO plan, the copay will mirror the home delivery
can be filled through home delivery or at the retail copay. Home delivery allows you to get a three-month
pharmacy. This includes generic contraceptives supply for the price of two copays. Specialty drugs
and some brand-name drugs in certain cases. Not all are shipped in a 30-day supply. You will pay one-third
drugs are covered. If you have questions, contact the three-month supply copay for specialty drugs
CVS Caremark. through CVS Specialty. Home delivery includes free
standard shipping.
The outpatient pharmacy benefit covers the
following methods: To get started with home delivery, get a 90-day
• Hormonal methods, like birth control pills, patches, prescription from your doctor plus refills for up to
vaginal rings and injections one year (if applicable). Complete the CVS Caremark
mail-order form available at caremark.com. Click on
• Barrier methods, like diaphragms and cervical caps “Plan & Benefits” and select “Print Plan forms.” Mail the
• Over-the-counter barrier methods (female condoms, form and prescription to Caremark at the address on
spermicides and sponges) the form. You can also ask your doctor to ePrescribe or
fax your prescription. If you have questions about home
• Intrauterine contraceptives (Mirena)
delivery, call the CVS Caremark Mail Order Pharmacy
• Implantable medications (Implanon) at 1-855-335-7698.
• Emergency contraceptives (Plan B, Ella)
20 Employee Health Benefits 2022 Enrollment GuidePreventive statin drugs
Certain low/moderate-dose generic statin drugs are considered preventive and will be
available at no extra cost to PPO plan and HDP members who meet certain criteria and do
not have a history of cardiovascular disease. The list is subject to change.
Included: High-intensity doses that are not included:
• Atorvastatin: 10–20 mg • Atorvastatin: 40–80 mg
• Fluvastatin IR: 20–40 mg • Lovastatin: 60 mg
• Fluvastatin XL: 80 mg • Rosuvastatin: 20–40 mg
• Lovastatin: 10–40 mg • Simvastatin: 80 mg
• Pravastatin: 10–80 mg
• Simvastatin: 5–40 mg
• Rosuvastatin: 5–10 mg
Excluded drugs
Check the list of drugs excluded from the CVS Caremark formulary. In many cases, the
generic equivalent for the brand-name excluded drug is covered and will cost you less.
In other cases, there is an alternative to the excluded medication. You pay 100% of the
cost for any excluded drug, and that cost is not applied to the deductible or OOP. View
the 2022 Excluded Drug list at pebcinfo.com.
Employee Health Benefits 2022 Enrollment Guide 21Enhancing
well-being
with vision
and dental
benefits
Vision benefits
Vision benefits are available through VSP. It’s easy to find a nearby network doctor. Get the most from your
coverage with bonus offers and savings that are exclusive to Premier Program locations — including thousands
of private practice doctors and over 700 Visionworks retail locations nationwide.
Create an account on vsp.com to learn more about your vision benefits and find an eye doctor near you.
Exclusions and limitations
Some brands of spectacle frames may be unavailable for purchase as Plan Benefits, or may
be subject to additional limitations. Covered Persons may obtain details regarding frame
brand availability from their VSP Member Doctor or by calling VSP’s Customer Care Division
at 1-800-877-7195.
NOT COVERED
• Services and/or materials not specifically included in this Schedule as covered Plan Benefits
• Plano lenses (lenses with refractive correction of less than ± .50 diopter), except as
specifically allowed under the Suncare enhancement, if purchased by Client
• Two pair of glasses instead of bifocals
• Replacement of lenses, frames and/or contact lenses furnished under this plan that are lost
or damaged, except at the normal intervals when Plan Benefits are otherwise available
• Orthoptics or vision training and any associated supplemental testing
To learn more about
• Medical or surgical treatment of the eyes
your vision benefits
• Replacement of lost or damaged contact lenses, except at normal intervals when services are
and find an eye otherwise available
doctor near you, • Contact lens modification, polishing or cleaning
create an account • Local, state and/or federal taxes, except where VSP is required by law to pay
at vsp.com. • Services associated with Corneal Refractive Therapy (CRT) or Orthokeratology
22 Employee Health Benefits 2022 Enrollment GuideVSP Advantage Plan
High option Low option for Denton County only
Network Non-network Network Non-network
reimbursement reimbursement
Vision exam $10 Up to $43 $10 Up to $43
Eyeglass lenses
Single vision $20 Up to $30 $25 Up to $30
Bifocal $20 Up to $45 $25 Up to $45
Trifocal $20 Up to $62 $25 Up to $62
Lenticular $20 Up to $100 $25 Up to $100
Standard progressive $20 Up to $45 $25 Up to $45
lenses
Frames* $200 allowance; 20% Up to $40 $150 allowance; Up to $40
off balance over $200 20% off balance
$250 at Visionworks over $150
$200 at Visionworks
Contact lenses** Frames and contacts Contacts in lieu of
BOTH available in glasses (12/12/24
same plan year in lieu frequency)
of eyeglass lenses
(12/12/12 frequency)
Non-elective Covered at 100% Up to $210 Covered at 100% Up to $210
Elective $200 allowance; not Up to $185 $150 allowance; Up to $185
to exceed $40 copay not to exceed $40
for contact lens exam copay for contact
lens exam
Service frequency
Exams 12 months 12 months 12 months 12 months
Prescription lenses 12 months 12 months 12 months 12 months
Frames 12 months 12 months 24 months 24 months
Contact lenses 12 months 12 months 12 months 12 months
Laser care Average 15% off the regular price or Average 15% off the regular price or
5% off the promotional price 5% off the promotional price
*NOT in lieu of contacts on 12/12/12 High option; ARE in lieu of contacts on 12/12/24 Low option.
**In lieu of only eyeglass lenses on 12/12/12 High option; frames and contacts available; Low option alternative 12/12/24 — contacts are in lieu
of glasses.
Employee Health Benefits 2022 Enrollment Guide 23Dental benefits
See which network For 2022, you can choose between the DeltaCare USA (DHMO)
is right for you: and the Delta Dental PPO plans.
Delta Dental HMO Plan (DeltaCare USA DHMO)
The DHMO Plan offers a wide range of dental benefits through
a network of participating dentists. Your DeltaCare USA plan is
a copayment plan. With your DeltaCare USA DHMO plan, some
preventive services are covered at 100%. Your plan also covers
many other dental services at a set copay. There are no annual
maximums and no deductibles.
Procedure Copayment
Office visit $0 per visit — office visit fee
(per patient, per office visit in
addition to any other applicable
patient charges)
Preventive services $0 exams
$10 sealant permanent molars
(per tooth)
$0 X-rays
Crowns $160–$380 — titanium
Orthodontics $1,150–$1,900 — child
$2,100 — adult
1. Go to deltadentalins.com and Root canals $110–$350
click “Find a dentist” at the top
of the screen. Extractions $50–$130
General anesthesia $80
2. Enter your ZIP code and
select the network based on When you enroll in DeltaCare USA DHMO:
the dental plan you chose.
• Delta Dental will assign a primary care dentist based on your
ZIP code.
3. For DeltaCare USA DHMO —
• You will receive welcome materials that include a welcome
select “DeltaCare USA.”
letter with your assigned dentist, plan booklet and ID card.
• You can request a change to your primary care dentist at
4. For DPPO — select “Delta
any time. Simply visit our website and log on to your online
Dental PPO.”
account or contact customer service. Change requests
received by the 21st of the month will be effective the first
5. Click on “Find a Dentist.” day of the following month.
• Each family member can select his or her own primary care
network dentist.
• Refer to your evidence of coverage/plan booklet for the full
copayment schedule.
• You must visit your primary dentist to receive benefits.
24 Employee Health Benefits 2022 Enrollment GuideDelta Dental PPO Plan (Delta Dental DPPO)
Visit a dentist in the PPO network to maximize your The DPPO dental plan will cover eligible dental
savings. Network dentists have agreed to reduced fees expenses after you meet any applicable waiting periods
and you won't get charged more than your expected and meet any deductibles. The plan is based on
share of the bill. If you cannot find a PPO network coinsurance levels that determine the percentage of
dentist, then Delta Dental Premier is your next-best costs covered by the plan for different types of services.
option. Under this plan, you have freedom to visit any
licensed dentist or specialist without a referral, however,
Delta Dental dentists offer cost protections and
convenient services. The Dental PPO Plan offers access
to Delta Dental dentists and out-of-network benefits.
Procedure Network Out-of-network
Deductible (per person) $50 (maximum of $150) $50 (maximum of $150)
Annual maximum benefit (per person) $2,000 $2,000
Preventive 100%, no deductible 100%, no deductible
• 2 cleanings per calendar year
• 2 exams per calendar year
• 2 fluoride treatments per calendar year for
dependent children under age 19
• Full mouth X-rays: 1 per 60 months
• Bitewing X-rays: 1 set per calendar year for adults;
2 per calendar year per child to age 18
Basic restorative 80% after deductible 80% after deductible
• Fillings
• Extractions
• Oral surgery
• Periodontal treatment
• Endodontics: Root canal
• General anesthesia: In conjunction with
covered oral surgery, and select endodontic
and periodontic procedures
Major restorative 50% after deductible 50% after deductible
• Benefits begin after 6 months of coverage
• Crowns
• Denture and bridges
• Implants
Orthodontia 50% after lifetime 50% after lifetime
• Benefits begin after 12 months of coverage; deductible deductible
orthodontic lifetime deductible and maximum $1,750 $1,750
(per person)
Employee Health Benefits 2022 Enrollment Guide 25Getting
the right
care at the
right time
Your care options
When you need health care, you have a variety of options. It’s important to remember that the emergency room
is only for life-threatening or serious conditions that require immediate care. If you do not have a life-threatening
condition, choosing another option will help you save time and money. View the care options chart to help you
pick the right place to go.
Emergencies
outside the U.S.
If you are traveling outside the
United States and experience a
life-threatening emergency,
you should go to the nearest
emergency room and contact
NurseLine When should you UnitedHealthcare’s Personal Health
NurseLine connects you with use 24/7 Virtual Visits? Support within 24 hours. To reach
registered nurses 24/7 at no Personal Health Support, call the
24/7 Virtual Visits are a convenient
additional cost. number on your health plan
option that may save you time and
ID card and select the prompt
To connect, call 1-877-370-2849. money. They’re a great choice for
for “Personal Health Support.”
You can also chat with a registered these non-emergency conditions:
When traveling outside the
nurse at myuhc.com. Nurses can • Allergies
United States, you are strongly
assist you in deciding where to • Cold/flu encouraged to obtain medical
go for care, help you understand
• Cough travel insurance.
your treatment options and answer
questions about medications. • Pink eye The U.S. State Department
website (travel.state.gov) provides
• Rash information about emergency
• Bladder infection medical coverage for U.S. citizens
• Migraine/headache traveling outside the country
and includes a list of insurance
• Many others companies that offer coverage.
26 Employee Health Benefits 2022 Enrollment GuideCare option When to use it How much it costs
24/7 Virtual Visits See and talk to a doctor via your PPO plan members pay a $0 copay.
smartphone, tablet or computer for HDP members pay the full service cost
non-emergency medical conditions. To until the deductible is met, then pay 20%
start a 24/7 Virtual Visit, register or sign in of that service.
at myuhc.com/virtualvisits or download the
UnitedHealthcare app.
Telehealth See and talk to your PCP, specialist or some Preventive care telehealth: Covered at
therapy providers via your smartphone, 100% for both PPO and HDP. Members
tablet or computer using your provider's pay $0.
telehealth system. For telehealth with your Diagnostic/Treatment telehealth visits:
own doctors, check their telehealth options PPO plan members pay a $25 copay for
when scheduling an appointment. You will PCP and Premium Care (PC) specialist
use their telehealth system. visits and $35 for non-PC specialist visits.
HDP members pay the cost of the service
until the deductible is met, then pay 20%
of that service.
Doctor’s office Your primary doctor knows you and your Preventive care visits: Covered at 100%
health history and can provide routine and for both PPO and HDP. Members pay $0.
preventive care and treatment for a current Diagnostic/Treatment office visits: PPO
health issue or refer you to a specialist. plan members pay a $25 copay for
PCP and PC visits and $35 for non-PC
specialist visits.
HDP members pay the cost of the service
until the deductible is met, then pay 20%
of that service.
Convenience Clinics like MinuteClinic® or Baylor Scott & PPO plan members pay a $25 copay.
care clinic White are located inside retail stores. If you HDP members pay the cost of the service
can’t get to the doctor’s office and the need until your deductible is met, then you pay
is not urgent, this is a great option for minor 20% of the service cost.
health conditions.
Urgent care center Centers such as PrimaCare offer treatment PPO plan members pay a $35 copay.
for non-life-threatening injuries or illnesses, HDP members pay the cost of the service
including sprains, minor infections and until your deductible is met, then you pay
minor burns. 20% of the service cost.
Emergency room (ER) If you need immediate treatment for a PPO plan members pay a $300 ER copay
life-threatening or critical condition, go to (copay waived if admitted) plus 20%
the nearest ER (network benefits apply). coinsurance (after deductible).
Do not ignore an emergency — call 911 if HDP members pay 20% coinsurance
the situation is life threatening. (after deductible) for ER services.
Freestanding A freestanding ER is not to be confused Visiting a freestanding ER can result
emergency room with an urgent care center or convenience in higher out-of-pocket costs for you,
care clinic. It is for immediate treatment for including balance billing charges,
a life-threatening or critical condition just especially if you are out of network.
like a regular ER.
24/7 Virtual Visits are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only
when services are delivered through a Designated Virtual Network Provider. 24/7 Virtual Visits are not intended to address emergency or
life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations.
Employee Health Benefits 2022 Enrollment Guide 27You can also read
